From the Guidelines
Lung cancer is the most common source of suprasellar metastasis. When cancer spreads to the suprasellar region, it most frequently originates from primary lung tumors, particularly non-small cell lung cancer, accounting for approximately 50% of all cases 1. Breast cancer represents the second most common primary source, followed by renal cell carcinoma, melanoma, and gastrointestinal malignancies. These metastases typically present with symptoms including:
- Visual field defects
- Headaches
- Diabetes insipidus
- Hypopituitarism
- Cranial nerve palsies depending on the exact structures involved. The pathophysiology involves hematogenous spread of cancer cells that breach the blood-brain barrier and establish growth in the suprasellar region, often affecting the pituitary stalk, hypothalamus, or optic chiasm. Diagnosis typically requires neuroimaging with contrast-enhanced MRI, and management generally involves a multidisciplinary approach including radiation therapy, systemic treatment of the primary cancer, and sometimes surgical intervention for tissue diagnosis or decompression of critical structures 1.
The natural history of untreated cerebral metastases is dismal, with median survival reported as less than 2 months 1. Although the use of surgery, radiosurgery, and whole brain radiation therapy (WBRT) improves survival, the goal of 2-year survival is still rarely achieved. Nevertheless, the advent of image-guided neurosurgical procedures and computer-assisted radiosurgery has made neurologic death rare in these patients, with overall survival more a function of the pace of the underlying cancer 1.
In terms of management, the methods available to treat patients with metastatic lung cancer to the brain include:
- Systemic corticosteroids, used to ameliorate the brain edema that typically accompanies intracranial metastases
- Whole-brain radiation therapy (WBRT)
- Surgical resection of the metastasis
- Stereotactic radiosurgery (SRS)
- Chemotherapy
- A judicious combination of these treatments 1.
From the Research
Suprasellar Metastasis
- The provided studies do not specifically discuss suprasellar metastasis, but rather focus on brain metastases in general, as well as breast cancer metastasis to other organs such as the lung 2, 3, 4, 5, 6.
- Breast cancer is known to metastasize to various organs, including the brain, but the specific location of suprasellar metastasis is not mentioned in the studies 2, 4, 6.
- The most common sites of metastasis for breast cancer are bone, liver, lung, and brain, but the studies do not provide information on the frequency of suprasellar metastasis 2, 4.
- Radiation therapy is a common treatment for brain metastases, but the studies do not discuss the specific treatment of suprasellar metastasis 3, 5.